Form C. 1924. STATE OF MAINE CERTIFICATE OF DEATH Place of Death Benard me Street No. Name James B.Benson How long a resident all ways Previous residence SexanalColor while Married, Single, Widowed or averued Divorced Deceased was husband of Eva-en Bensa Deceased was wife of Date of Birth: Year 1856Month Feb Day 24 Age: Years 69 Months 10 Days 24 Occupation Fisherman Place of Birth Bernard mens Name of Father Berymon Bensager Birthplace of Father Remard - Occupation of Father mirehant Maiden Name of Mother Jessee Renson Birthplace of Mother Princildinshoid (Signature of Informant) (Address) Filed 19 (OVER) (Local Registrar)